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General NPI Number Information
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NPI Number | 1356318695
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Entity Type | Organization
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Legal Business Name | PENGE CHIROPRACTIC HEALTH CENTER PA
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Dates
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Enumeration Date | 03/07/2006
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Last Update Date | 03/02/2012
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Provider Practice Location Address
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Address Line | 2727 S TAMIAMI TRL SUITE 3
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City | SARASOTA
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State | FL
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Zip | 34239-4524
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Country | US
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Telephone | 941-365-4343
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Fax | 941-365-4838
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Provider Business Mailing Address
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Address Line | 2727 S TAMIAMI TRL SUITE 3
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City | SARASOTA
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State | FL
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Zip | 34239-4524
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Country | US
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Telephone | 941-365-4343
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Fax | 941-365-4838
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH J PENGE
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Credential | DC
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Telephone | 941-365-4343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | CH0006708
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License Number State | FL
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